Therapeutic Advances in Ophthalmology最新文献

Background: Scleral allograft-reinforced cyclodialysis intervention can achieve sustained intraocular pressure (IOP) reduction by enhancing uveoscleral outflow in hypertensive patients with primary open-angle glaucoma (POAG) failing medical therapy.

Objectives: To evaluate clinical outcomes of bio-interventional uveoscleral outflow enhancement surgery through 12 months of follow-up in POAG subjects who are inadequate responders to IOP-lowering medical treatment.

Design: Prospective interventional real-world evidence trial.

Methods: Patients with POAG and medicated baseline IOP >21 mmHg failing medical therapy underwent bio-interventional uveoscleral outflow enhancement surgery with an ab-interno allograft-reinforced cyclodialysis. Acellular allogeneic scleral bio-tissue was micro-trephined, shaped, and loaded in a delivery cannula for internal scaffolding. Endoscleral reinforcement of the cyclodialysis was then performed to maintain the internal uveoscleral filtration conduit. Effectiveness outcomes such as IOP and IOP-lowering medication use, as well as ocular safety and tolerability, were analyzed through 12 months post-op.

Results: Fifty-one eyes were enrolled with a baseline medicated IOP greater than 21 mmHg. The average age was 70.9 ± 8.5. The mean best corrected visual acuity (BCVA) at baseline was 0.40 ± 0.32, and the mean medicated IOP was 25.7 ± 4.4 mmHg on 1.2 ± 1.3 IOP-lowering medications. In 83% of cases, visually significant cataract comorbidity was present and treated with adjunct phacoemulsification. The bio-interventional cyclodialysis surgery and scleral reinforcement were successfully performed in all cases. The procedures were well tolerated, and there were no visually significant or serious, vision-threatening ocular adverse events. Durable and sustained reinforcement of the cyclodialysis was achieved through 12 months of follow-up without migration, displacement, or attrition of the allograft bio-scaffold. At 12 months post-op, there was a statistically significant (p < 0.01) and sustained reduction in IOP from 25.7 + 4.4 mmHg at baseline down to 15.4 ± 4.5 mmHg, with a concurrent 42% reduction in IOP-lowering medications. 86.7% of subjects achieved a medicated IOP <18 mmHg while on fewer or the same number of IOP-lowering medications.

Conclusion: Uveoscleral outflow enhancement can be surgically enhanced in an ab-interno approach through bio-interventional cyclodialysis with adjunct scleral allograft reinforcement to lower IOP in open-angle glaucoma patients who are inadequate responders to medical therapy.

Trial registration: The study was registered with clinicaltrials.gov NCT05506423.

Background: This study aims to identify ocular fundus blood flow biomarkers, using swept-source optical coherence tomography angiography (SS-OCTA), that reflect choroid plexus (CP) changes in patients with white matter hyperintensities (WMHs).

Design: This is a retrospective analysis based on prospective data.

Methods: The study was an analysis of collected data from patients with WHMs who underwent multimodal magnetic resonance imaging (MRI) and SS-OCTA (FRESH-CSVD study, NCT06431711). Automatic segmentation was used to calculate the volumes of CP and WMHs. The bilateral CP asymmetry index was defined as the value of the difference in volume between the right and left CP, divided by the volume of the left CP. The association between SS-OCTA parameters, CP volume and its asymmetry index, and WMH volume (WMH-V) was analyzed using a LASSO-derived logistic regression model, with mediation analysis to explore their connections.

Results: The study included 240 eyes from 137 patients. A significant correlation was found between the bilateral CP asymmetry index and WMH-V (β = -6.03, 95% CI: -11.36 to -0.70, p = 0.027). WMH-V was correlated with the optic nerve head choriocapillaris perfusion area (ONH CC PA) (β = -2.95, 95% CI: -5.62 to -0.28, p = 0.031). The bilateral CP asymmetry index was also related to ONH CC PA (β = 0.07, 95% CI: 0.01 to 0.13, p = 0.027). Mediation analysis showed that WMH-V mediated 15.11% of the association between the bilateral CP asymmetry index and ONH CC PA (p = 0.036), but this mediation effect disappeared after adjusting for age.

Conclusion: These findings suggest that the morphological changes of the CP have a significant impact on the ONH blood flow in patients with WMHs. The ONH CC PA shows potential as a biomarker for detecting morphological changes of CP among WMHs patients.

This study aims to provide an update on infectious scleritis (IS). A comprehensive search was conducted using Google Scholar, Scopus, and PubMed. IS is a rare but critical condition that presents significant diagnostic challenges and often leads to poor visual outcomes. It accounts for approximately 5%-10% of scleritis cases and warrants significant attention due to its delayed diagnosis. Ocular surgery is the primary contributor to IS, accounting for a substantial proportion of cases ranging from 58% to 83%, followed by trauma contributing to approximately 10% of cases. IS can be caused by various microorganisms, including bacteria (86%-87%), fungi (11%-13%), viruses, and parasites. Conjunctival hyperemia is a prevalent manifestation in approximately 98% of IS cases, while scleral necrosis is observed in around 93% of cases. Distinguishing IS from inflammatory scleritis before initiating steroid treatment is crucial. Surgical debridement of infected tissue, accompanied by appropriate topical and systemic antibiotic therapy significantly improves treatment outcomes by removing infected tissue and reducing the infection burden. Early surgical intervention markedly increases the likelihood of preserving the eye globe in severe cases. Risk factors for poor visual outcomes include poor visual acuity at presentation, associated endophthalmitis, keratitis, fungal etiology, and medical therapy without surgical debridement. Early diagnosis of IS is crucial as the disease can progress rapidly and lead to vision loss. While bacterial infections are the most common etiology of IS, the prognosis is particularly poor in cases of fungal IS. Surgical interventions, when combined with appropriate medical treatment, improve outcomes.

An 8-year-old girl presented with left leukocoria, prompting an evaluation that revealed bilateral intraocular masses, including a right upper nasal choroidal lesion and a large left heterogeneous mass with exudative detachment. Imaging and systemic assessment uncovered multiple intracranial lesions, miliary lung lesion, a facial lesion, and a right tibial lesion. A strongly positive tuberculin test and a history of close contact with a tuberculosis (TB) patient led to the diagnosis of disseminated TB. Treatment with anti-tuberculosis therapy and systemic steroids initially resulted in improvement, including regression of the ocular tuberculomas and enhanced visual acuity. However, the patient developed severe headache due to non-communicating obstructive hydrocephalus, necessitating surgical intervention. Despite intensive care, the patient ultimately succumbed to the condition. This case highlights that ocular TB lesions can mimic intraocular tumors and underscores the importance of comprehensive evaluation, including multimodal imaging and systemic work-up, for early diagnosis and management of disseminated TB.

Charles Bonnet syndrome (CBS) is characterised by visual hallucinations in individuals with significant visual impairment. This literature review and case report focus on the unique presentation of CBS in an 82-year-old woman with age-related macular degeneration, who experienced visual hallucinations for over 10 years. The aim is to raise awareness of CBS among healthcare professionals and the public, addressing the diagnostic challenges that contribute to its underdiagnosis and mismanagement. A literature review was conducted to assess the prevalence and diagnosis of CBS. Databases including Google Scholar and PubMed were searched using the terms 'Charles Bonnet Syndrome', 'Case report' and 'Diagnosis'. The patient reported a range of visual hallucinations, from simple geometric shapes to highly detailed figures. A diagnosis of CBS was made based on her visual impairment and the nature of the hallucinations. No treatment was required, and the patient was reassured that the hallucinations were benign and unrelated to any psychiatric or neurological disorder. This case highlights the diagnostic challenges associated with CBS, which is often misdiagnosed or overlooked due to its rarity and the hesitancy of patients to disclose their symptoms. The long period of unreported hallucinations in this case emphasises the need for greater awareness among healthcare providers, enabling earlier recognition of CBS and differentiation from other conditions. The wide range of hallucination types seen in CBS adds to the complexity of the syndrome. The key takeaway is that increased awareness and recognition of CBS are essential for proper diagnosis, reducing patient anxiety and avoiding unnecessary treatments. This case contributes to the existing literature by illustrating the broad spectrum of CBS presentations and advocating for enhanced education on the condition.

Corneal crosslinking (CXL) was first introduced in clinical practice in 2003. Since then, this procedure has been established as the first-line treatment in the management of progressive keratoconus. Over the last years, many different protocols have emerged, each one of them with variable clinical outcomes and safety profile. Progression of keratoconus after primary CXL is very rare, but it has been reported in the literature. This review summarises the existing data on repeated CXL after primary failure, emphasising on clinical efficacy and safety.

Purpose: To evaluate the effect of preoperative nepafenac on pain following alcohol-assisted photorefractive keratectomy (PRK).

Settings: Tel-Aviv Sourasky Medical Center-a tertiary medical center.

Design: Observational case-series.

Methods: Setting: Refractive center. Study Population: 205 PRK patients grouped randomly into five according to pain-management protocols: (1) paracetamol/ibuprofen (Parac-Ibupr group, n = 39), (2) high-dose oxycodone/naloxone only (Oxy-only group, n = 45), (3) oxycodone/naloxone and postoperative 0.1%-nepafenac (Oxy-Nep group, n = 36), (4) oxycodone/naloxone and preoperative and postoperative 0.1%-nepafenac (Nep-Oxy-Nep group, n = 42), and (5) preoperative and postoperative 0.1%-nepafenac only (Nep-only group, n = 43). Preoperative nepafenac was administered three times daily for 2 days. Main Outcome Measures: Mean and maximal pain levels (postop days 1-5), duration of tearing/photophobia, number of pain tablets taken, uncorrected visual acuity (UCVA), side effects and epithelial healing delay.

Results: Mean pain scores differed significantly between groups (p < 0.001)-lowest in groups receiving preop nepafenac (Nep-only: 1.8 ± 1.6, Nep-Oxy-Nep: 2.3 ± 1.5) compared to the Oxy-Nep (3.2 ± 1.9), Oxy-only (3.8 ± 1.7), and Parac-Ibupr (4.8 ± 1.6) groups. Similar findings were observed with maximal pain scores. Total number of pain tablets taken was lowest in the Nep-only group. Duration of photophobia was shortest in groups receiving preoperative nepafenac (p < 0.001). Duration of tearing was longest in the Parac-Ibupr group (p < 0.001). Nausea/vomiting occurred in 20% of the Oxy-only group (p < 0.001). There were four cases of delayed epithelial healing-all in groups not treated with nepafenac. One-month UCVA did not differ between groups. No additional independent factors were found to be associated with pain except age.

Conclusion: Adding preoperative nepafenac significantly reduced pain and photophobia with complete epithelial healing. Addition of oral opiates to nepafenac treatment had little analgetic benefit.